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General NPI Number Information
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NPI Number | 1801317722
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Entity Type | Organization
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Legal Business Name | FAIRMOUNT FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3732 FAIRDALE RD
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City | HEMPHILL
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State | TX
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Zip | 75948
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Country | US
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Telephone | 409-579-2044
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Fax | 409-579-2104
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Provider Business Mailing Address
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Address Line | 3732 FAIRDALE RD
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City | HEMPHILL
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State | TX
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Zip | 75948
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Country | US
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Telephone | 409-579-2044
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Fax | 409-579-2104
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Authorized Official
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Title or Position | CREDENTIALING ADMINISTRATION
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Name | PRISCILLA PIPES
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Credential | RHIT
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Telephone | 936-615-4265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | AP123751
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License Number State | TX
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